The Putting Patients First Field Guide

Global Lessons in Designing and Implementing Patient-Centered Care

Planetree Foundation, Susan B. Frampton, Patrick A. Charmel, Sara Guastello

• Publisher: Jossey-Bass
• Year: 2013
• ISBN:
  9781118450086
• Edition: 1
• Topic: Medicine
• Subtopic: Public Health, Administration & Care

"This book answers 'why not' and 'how to' for health care accreditation bodies, quality experts, and frontline professionals, moving the reader from timely information, to inspiration, and through patient-centered action with practical tools and potent case studies."

—Paul vanOstenberg, DDS, MS, vice president, Accreditation and Standards, Joint Commission International

"This superb guide from Planetree illustrates that providing high-quality, high-value, patient-centered health care is not a theoretical ideal. The case studies make clear that these goals are attainable; they are being achieved by leading health care organizations worldwide, and there is a clear road map for getting there—right here in this book."

—Susan Dentzer, senior policy adviser to the Robert Wood Johnson Foundation

"At IHI, we follow the principle, 'all teach, all learn'—the idea that everyone, everywhere has something to teach, and something to learn. This remarkable and indispensable guide is as pure an example of this principle as I've come across."

—Maureen Bisognano, president and chief executive officer, Institute for Healthcare Improvement

"The International Society for Quality in Health Care's mission is to inspire, promote, and support continuous improvement in the quality and safety of health care worldwide. It is in this spirit that we welcome this new book on patient-centered care. As in their previous work, the authors demonstrate just how critical it is to develop an organizational culture that puts patients first."

—Peter Carter, chief executive officer, International Society for Quality in Health Care

Part 1

Patient-Centered Care as a Fundamental Strategy for Achieving High-Quality, High-Value Care

1

The Patient-Centered Care Value Equation

Patrick A. Charmel, Susan Stone, and Dan Otero

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I retired from nursing recently, and moved to a new community, but really wanted to stay connected to my life's work in some meaningful way. I decided to volunteer at the local hospital, and was trained to be a “Care Partner” for patients who don't have family in the area to help them following a hospitalization. The hospital connected me with Shirley, a spirited, colorful, and determined sixty-eight-year-old woman who had overcome many adversities in her life. Shirley had been admitted to the hospital nine times in a ten-month period, with two of the readmissions occurring within less than a month of her previous discharge date. Her primary diagnosis was chronic obstructive pulmonary disease (COPD). She had been admitted numerous times for pneumonia, and had been prescribed a number of medications, steroids, and inhalers to control her COPD symptoms.

During one of these admissions, a Patient Activation Measure tool designed to assess patients' ability to manage their own care by examining their knowledge, skills, confidence, and readiness for change, determined that Shirley truly did not believe she had control of or confidence in managing her own medical care. Though she had previously refused all postdischarge community-based intervention offerings (including home care, hospice, and assisted living placement), the findings from this assessment made it clear that Shirley would benefit from additional support to help her understand her role in managing her health, and from coaching to do so. That was my role as her Care Partner. I visited Shirley at her home weekly and we spoke on the phone in between visits. I would ask her if she had taken her daily medications and would often find that she had forgotten her inhaler or anti-anxiety medication. Knowing of Shirley's history of anxiety, I was able to connect her to a weekly stress management clinic at the Senior Center. Following her first group session, Shirley reported to me with such relief that she went home and slept for twelve hours straight. She couldn't believe how effective just that one session was for reducing her anxiety. Over time, our relationship continued to develop, and she grew to trust me. Eventually, with supports through the hospital, I was able to convince Shirley to work with the Hospice team after her final hospital admission. Shirley did die, but she did so in her own home and on her own terms. She spent her final days surrounded by the things and people she loved, not in and out of the hospital.

—Monica

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For many leaders of health care organizations around the world, the question is not whether patient-centered care is the right thing to do. You need only consider what you would want should you find yourself or a loved one in need of medical care to conclude that the answer to that question is an unequivocal yes. However, this decision is less clear as leaders contemplate the financial impact of adopting a patient-centered approach to care.

Stories like Shirley's, though, suggest that patient-centered care may indeed be among the most powerful levers for achieving the high-quality, high-value care that is the aim of health reform efforts worldwide. Through systems designed to assess Shirley's ability to manage her condition and interventions to engage her as a more effective steward of her own care, Shirley's last weeks and months were spent on her own terms, not being moved in and out of the hospital. From both a quality and value perspective, this was the best possible outcome—for Shirley and the hospital, alike.

At a time when global health care reform efforts are challenging providers to reduce costs while improving quality, all sensible health care leaders must consider the merits of patient-centered care both from a principled perspective and an economic one. In this chapter, through a series of field examples, we will demonstrate that patient-centered care need not come at the expense of sound fiscal management; in fact, patient-centered care can be the foundation of a successful business strategy.

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Field Example: Sharp Memorial Hospital, San Diego, California, USA

In 2009, Sharp Memorial Hospital, a 675-bed metropolitan community hospital, had been working diligently for a number of years to improve the health care experience it provides to its patients. Since 2001 Sharp HealthCare had been on a journey to transform its organizational culture and to be the best place to work, practice, and receive care as measured by employee, physician, and patient satisfaction. In fact, Sharp Memorial Hospital had made many improvements in quality outcomes, employee satisfaction, and physician satisfaction with above-average performance for all three. Patient satisfaction however, continued to lag below the 50th percentile as measured in the Press Ganey, Inc. Large Hospital Database.

Key among the strategies to improve the patient experience was using proven business exemplars such as Baldrige and the Magnet Recognition Program as roadmaps for success. In 2007, Sharp Memorial Hospital, along with the entire Sharp HealthCare organization, was recognized as a Baldrige National Quality Award–winning organization by the President of the United States. In 2008, the Magnet Recognition Program recognized Sharp Memorial Hospital as a center of nursing excellence. In 2009, Sharp Memorial Hospital added the Planetree Patient-Centered Hospital Designation criteria as an additional exemplar to guide improvement in the patient experience.

While preparing to open the new Stephen Birch Healthcare Center at Sharp Memorial Hospital, the executive team convened a group of internal stakeholders to imagine an organization that is truly responsive to the needs of employees, physicians, patients, and families. This group included team members from all levels and disciplines within the organization. They spent an entire week dreaming, imagining, and crafting a declaration creating a clear future state for all patients. The team envisioned the future where all team members would be masters in the art of caring, dedicated to creating memorable moments for every patient and becoming beacons of hope for the health care community through the demonstration of a truly transformational health care experience.

A hospital-wide collaborative patient and family-centered council conducted a self-assessment and gap analysis to determine areas of strength along with identifying the opportunities for improvement using the Patient-Centered Care Improvement Guide Self-Assessment Tool (www.patient-centeredcare.org). The gap analysis identified five priority focus areas. The Planetree organization conducted multiple focus groups with over three hundred individuals including patients, family members, staff, physicians, team members, and executives. The findings of these focus groups confirmed that much success had been made and encouraged the hospital to continue with planned program enhancements. Priority focus areas included personalized patient education, discharge preparation, increased access to health information, consistent implementation of integrative healing modalities, and parking. Table 1.1 summarizes the program enhancements implemented by the hospital-wide collaborative patient- and family-centered council.

Table 1.1 Sharp Memorial Hospital Patient- and Family-Centered Care Program Enhancements

Priority Focus Area	Patient- and Family-Centered Care Program Enhancements
Personalized patient education during hospitalization	Implementation of a television-based health information portal that converts the patient television into a computer and interactive patient education device. This program facilitates patient education and tracking as well as brings the Internet's resources and entertainment to the patient's fingertips. Implementation of the Health Information Ambassador Program to facilitate health information to the patient from the Consumer Health Library.
Discharge preparation and education	Implementation of a hospital-wide Care Partner Program to improve patient and family education and discharge preparation.
Increased access to patient health record through a shared medical record process	Creation of patient health record journal called My Health Record that allows the patient to access a summarized version of their daily medical record in order to increase patient and family participation and compliance in the care plan.
Consistent implementation of integrative medicine offerings	Increased the number of integrative healing offerings in order to obtain consistent implementation throughout all units. Modalities included: Meditation Healing touch Reiki Guided imagery Comfort hand massage Arts for healing Healing music Pet therapy Aromatherapy
Improved parking	Complimentary discharge van service for patients (one guest is permitted per patient). Purchase of a seven-passenger, wheelchair-accessible van equipped with child-safety seats.

The outcome of these patient- and family-centered program enhancements was sustained improvement in employee, physician, and patient satisfaction in addition to sustained improvement in the percentage of hospital patients assessed as receiving “perfect care” as measured by the Centers for Medicare and Medicaid Services. Sharp Memorial Hospital for the past three years outperformed 90 percent of hospitals across the United States in employee, physician, and patient satisfaction. Sharp Memorial Hospital is currently the only hospital in the world to have concurrent Planetree Patient-Centered Hospital Designation for patient-centered care excellence, Magnet designation for nursing excellence, and be part of a health care system that has received the Malcolm Baldrige National Quality Award. In addition the following awards have demonstrated the outstanding outcomes accomplished:

• 2012 HealthExecNews World's Most Beautiful Hospital
• 2012 Becker's 100 Great Hospitals
• 2012 The Joint Commission Top Performer on Key Quality Measures
• 2011 The Union Tribune San Diego's Best Hospital
• 2011 Health Grades Outstanding Patient Experience Award
• 2011 Soliant Health Top 10 America's Most Beautiful Hospitals
• 2010 Morehead Apex Award
• 2010 Soliant Health America's Most Beautiful Hospital
• 2010 Press Ganey Inpatient Top Improver Award

Figure 1.1 SMH Employee and Physician Satisfaction Percentile Rank (FY2008–FY2011)

Figure 1.2 SMH Overall Patient Satisfaction Percentile Rank (FY2008–FY2011)

Figure 1.3 SMH Overall Percentage Perfect Care Compliance Composite (FY2008–FY2011)

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The Value Equation

As this field example illustrates, patient-centered care and high-value health care are not an either-or proposition. In fact, there can be no discussion of the value equation for patient-centered care without first establishing this fundamental point: patient-centered care is safe, high-quality care. Health care can not be patient-centered if it is not grounded in clinical excellence and sound patien...

Table of contents

• Cover
• Title page
• Copyright page
• Tables and Figures
• Dedication
• Acknowledgments
• The Editors
• The Contributors
• Prologue
• Foreword
• Introduction: Patient-Centered Care Goes Global
• Part 1: Patient-Centered Care as a Fundamental Strategy for Achieving High-Quality, High-Value Care
• Part 2: Challenges and Solutions in Patient-Centered Care
• Part 3: Activating Stakeholders to Create Organizational Change
• Index